Reporting on patient target failures and over-stretched resources at the NHS is an almost daily occurrence as the 65 year old institution undergoes significant changes in the way healthcare needs can be delivered in the 21st century. Many NHS buildings and A&E departments, which still remain in daily use today may also originate from the early or middle years of the 20th century, and in some instances, even earlier.

As with many other public buildings, most notably schools, colleges and nurseries, the construction or ongoing renovation of hospitals almost invariably included the widespread use of asbestos insulation until the late 1970s and early 1980s at least when the first asbestos ban came into force. Asbestos was extensively applied in boiler and pipe insulation, the lining of heating ducts, and installing building materials, such as wall board, floor and ceiling tiles and electrical wiring.

Today, asbestos awareness of its long legacy of use and fatal outcome for thousands of mesothelioma victims still does not prevent the deadly risk of exposure continuing to be reported.

No knowledge of asbestos being present

In a recent case, NHS Trust workers were potentially at fatal risk of exposure to asbestos material for more than a decade three hospitals in Hertfordshire. Between April 2000 and December 2011, small repairs and maintenance projects being carried out by an NHS estates team could have disturbed asbestos fibres. Yet during the 11-year period, while the Trust had identified asbestos-containing materials at their sites they failed to put a management or monitoring plan in place.

Equally worryingly, it was also found that the workers had no knowledge of asbestos being present and were not trained to identify and protect themselves from the potential health risk. They only became aware that asbestos was present when additional surveys were being carried out, which led to a Health and Safety Executive investigation and a prosecution brought. The West Hertfordshire Hospitals NHS Trust was fined £55,000 and ordered to pay £ 34,078 in costs after pleading guilty to four breaches of the Control of Asbestos Regulations 2006 and a single breach of the Health and Safety at Work etc Act 1974.

However, for the NHS estates team workers, the case many not be closed for the rest of their lives as they still have no way of knowing if they have been exposed and inhaled airborne fibre dust particles. The gestation period for developing mesothelioma cancer can be between 15 to 50 years or more before asbestosis symptoms first appear.

Some hospitals contain more dangerous asbestos types

While much of the asbestos discovered today is almost certain to be white chrysotile, a ‘low risk’ but still a carcinogenic form, there are some hospitals, which have been found to contain the more dangerous blue ‘crocidolite’ or brown ‘amosite’ asbestos types. The discovery or disturbance of any asbestos-containing materials found in a hospital environment should be immediately and robustly managed, but all too often this is not the case.

Early in 2014, it was suggested a new £1.6 million building could replace a Derbyshire hospital, built in 1925, which had been closed to patients since the previous autumn after asbestos was discovered in a boiler room during a routine inspection by staff. In 2013, hospital staff were advised to go to their doctors after asbestos was disturbed in the basement of building where the training and legal departments of the Royal Liverpool Hospital are based.

Other recent examples include a health trust in Northern Ireland, which was fined £10,000 following an investigation into the failure to pass information about the known presence of asbestos in a Belfast City hospital to building contractors, and a fine of £7,580 handed out to Sunderland NHS Foundation Trust for also failing to pass information on the location or condition of asbestos to contractors after a survey led to the discovery of asbestos insulating board.